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A Comparison of Quality Improvement Practices at Adult and Pediatric Trauma Centers*

Cooper, Carmen Gayle BSc1; Santana, Maria Jose MPharm, PhD2; Stelfox, Henry T. MD, PhD, FRCPC3

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p e365–e371
doi: 10.1097/PCC.0b013e3182917a4c
Online Clinical Investigations

Objectives: Quality assurance practices are structured performance improvement and patient safety processes designed to continuously monitor, evaluate, and improve the performance of a trauma program. These practices are integral in the provision of quality injury care, and yet no comprehensive description of existing quality improvement practices used by pediatric trauma centers is available. Therefore, we compared the quality improvement programs used in adult and pediatric trauma centers by performing a reanalysis of our recent survey of trauma quality improvement practices in Canada, United States, Australia, and New Zealand.

Design: Prospective observational study.

Setting: Pediatric and adult trauma centers in United States, Canada, and Australasia.

Patients: None.

Interventions: None.

Measurements: We surveyed 184 trauma centers verified by professional trauma organizations in the United States, Canada, and Australasia regarding their quality improvement programs. Centers were classified according to population served (adult, adult and pediatric, or pediatric patients), and quality improvement programs were compared using descriptive statistics.

Results: Most of the trauma centers reported engagement in quality improvement activities. Adult centers devoted a larger percentage of their quality indicators to the measurement of safety (adult 50% vs adult and pediatric 53% vs pediatric 38%, p < 0.001), whereas pediatric centers placed a greater emphasis on the timeliness of care (20% vs 24% vs 30%, p < 0.001). Few centers used quality indicators to measure the patient-centered nature of care, long-term outcomes, or secondary injury prevention.

Conclusions: Opportunities for the improvement of pediatric quality improvement programs exist including a need to determine the optimal structure for trauma quality improvement, develop patient-centered quality indicators of injury care, measure long-term outcomes, and create measures of secondary injury prevention.

1Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

2Department of Medicine, Institute for Public Health, University of Calgary, Calgary, Canada.

3Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, Canada.

* See also p. 828.

Funding sources had no role in the design, conduct, or reporting of this study.

Mr. Cooper and Dr. Stelfox had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by a Partnership in Health System Improvement Grant (PHE-91429) from the Canadian Institutes of Health Research and Alberta Innovates; and Markin Undergraduate Student Research Program in Health and Wellness.

Dr. Stelfox is supported by both a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator award from Alberta innovates. Mr. Cooper is supported by a Markin Undergraduate Student Research Program award in Health and Wellness. Dr. Santana has disclosed that she does not have any potential conflicts of interest.

For information regarding this article, E-mail: mjsantan@ucalgary.ca

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies